Livalo Prior Authorization Resources

Find the right PA form for your patient's payer, get the ICD-10 codes you need, and download appeal templates — all in one place.

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.
California - Uniform Prior Authorization FormCalifornia
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc.
Cigna - General Medication Prior Authorization FormCigna Corporation
Colorado - Uniform Prior Authorization FormColorado

ICD-10 codes for Livalo Prior Authorizations

E78.0Pure hypercholesterolemia
E78.9Disorder of lipoprotein metabolism and other lipidemias, unspecified
E78.01Familial hypercholesterolemia

Brand Resources

Pharmacy List Pharmacy List resource
Formulary InformationFormulary Information resource

Support for Getting Your Patient on Livalo

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